Malaria.--II
Authors: N. H. Fairley
Journal: BMJ (1949)

KIDNEY BRft= 9The day after that she was much worse again and another run of eight hours was given on the machine.The results of this are shown in Chart 3. Her condition was very greatly improved.There was still only 45 ml. of urine.Three days later the patient's condition was again serious and another run of six hours was given.The clinical improvement of the patient was very striking.She was comatose at the beginning of each one of these runs on the machine; at the end she was quite bright.The delirium and coma had disappeared.The patient would drink small quantities of fluid, would respond to questions and conversation, and stated that she felt much better.In spite of the pronounced oedema there was some appearance of intelligence in her face.During the runs on the machine samples of blood, ascitic fluid from the peritoneal cavity, and spinal fluid were removed, and N.P.N. and other tests done on these.After the last dialysis there was a moderate secretion of urine, and next day there was an enormous secretion of 4,000 ml. of urine.Subsequently the patient made a pro- gressive and uninterrupted recovery and returned to normal health.During the next two weeks samples of both blood and spinal fluid showed a progressive fall of N.P.N., until on the twenty-fifth day these had both reached normal.The oedema had entirely disappeared.The patient was up and about, and was in normal health.At this stage the gynaecologists reported that the foetus was not present in the uterus.While there was no record of its escape, I think one cannot assume that the dialysing apparatus removed it by this means.The patient was in hospital 33 days.The only remaining abnormality was a lack of concentration on the two-hour test.The urinalysis otherwise was quite normal and the two-hour test showed a concentration only up to 1012.However, as shown on the final point on Chart 4, 60-.4,000 - 4 3,000 - INTAKE OUTPU DECP6 21 3 5 2 2 31 2 4 JAN/47 CHART 4.-Case 1. Showing later stages of recovery.N.P.N. and water balance returned to normal.on the sixty-first day the blood N.P.N. was 28 mg.per 100 ml.The spinal fluid N.P.N. was also 28 mg.per 100 ml., and the two-hour test showed considerable improvement.Here the concentration went up to 1018, and the day and night quantities were fairly normal.The patient has gone back to her regular work and is in normal health.She has since married and given birth to a normal child.Kidney function was watched closely throughout pregnancy, and at no time was there evidence of toxaemia or impaired function.Case 2A married woman aged 40 was seen by the courtesy of Dr.J. Crosbie.After caesarean section, when a blood transfusion was given, there was oliguria, and the urine contained haemo- globin and haematin.She passed only 3 to 5 ml. of urine daily for eight days, at which time the blood N.P.N. was 179 mg. per 100 ml. and the patient was showing signs of uraemia.She was then treated for 26 hours with the artificial kidney.Fifty-four feet (16.5 metres) of tubing was used and 70 g. of N.P.N. was removed from the blood.The following day the urinary secretion increased to 210 ml., rising to 6.730 ml. on the fifth day.The patient gradually improved, and has made an excellent recovery.Renal function has returned to normal and she is in normal health.OcT.22,